Care for COVID-19

A pandemic lifestyle care intervention.

The current COVID-19 coronavirus pandemic is an emergency on a global scale.

Elena+ offers digital lifestyle coaching on a variety of topics such as mental health, physical activity and COVID-19 health information to help keep us all healthy, protect our healthcare systems and protect our frontline healthcare workers.

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Intervention Overview

COVID-19 health information

Having individuals within society enact COVID-19 guidelines widely is vital for tackling the virus [5]. However, this at present requires a relatively large information processing burden on the part of the individual, which must vigilantly pay attention to developments. Despite information being made widely available in the media, one-way communication is known to be less memorable than interactive, two-way communication which activates socio-cognitive structures in memory [20]. In addition to this, one-way media channels must compete with a more interactive social-media, which presently contains the danger of misinformation and “fake news” [5], for example, recent stories claiming 5g mobile-phone networks caused the COVID-19 outbreak [21]. Certain individuals in traditionally at-risk groups lower in selfefficacy and/or health-literacy may be particularly vulnerable for a failure to follow guidelines [4], [22] and fake news stories [23].

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To tackle these factors, Elena+ offers the COVID-19 health information module based on trustworthy and legitimate sources including the World Health Organization and other governmental bodies and/or charities/agencies. Previous work has shown TBCBs as a particularly effective way of relaying health literacy information, and text-messaging is something now virtually the entire population has strong usage experience with [24]. Therefore, by using a TBCB it is expected we can make guidelines and information more accessible to the general population, contributing strongly to an integrated communicative strategy that can reach widely across society. Following a coaching session, we enable users to select tips (i.e. behavioral intentions) related to COVID-19, to track which public health guidelines they follow.

Physical activity

Currently individuals have strict requirements to stay at home [25] and the majority of fitness facilities are closed off to the public. In such situations the typical fitness routine that individuals have developed are often impossible to follow or severely limited. In addition, by practicing social distancing guidelines, individuals are required to exercise in solitude mainly, which may pose an issue for individuals that prefer socially oriented exercise contents [26], 27] (i.e. exercise classes, running with friends) and now experience a lack of motivation or ideas for types of solo exercise.

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The physical activity (PA) module delivers a variety of sub-topics and enables the development (or continuation) of physical activity routines to contribute to strengthened immune systems and improved population health. By providing information on suitable activity types (cardio, strength, mixed) that individuals can perform whilst maintaining social distancing guidelines, we promote the individual’s ability to resist temptations and remain adherent to public health policy. Health literacy information included in the intervention content aims to influence individual expectancies, self-efficacy and domain expertise in exercise. Following each coaching session, users may select tips (i.e. behavioral intentions) to implement such as exercises or activities. Extant research on CAs and TBCBs has shown how digital lifestyle interventions can coach individuals to improve a variety of health behaviors. Multiple interventions have tackled obesity [8], diabetes [28], [29], physical activity [30]. In addition, the commercial world has highlighted how gamification can be used to improve engagement in smartphone apps (e.g. Garmin fitness). The PA module therefore aims to adhere to the best practices as outlined in academic and practice by taking inspiration from existing chatbot and gamified PA interventions.

Mental health

Across most of the world, mental health is under increased strain due to both increasing health anxiety levels combined with social distancing requirements [31]. As individuals are required to stay at home for long periods, many routines built up to ensure mental resilience [32] (performing a relaxing hobby, meeting with friends) are currently impossible. In addition, social relationships within the home may be under duress, as individuals are suddenly required to spend long periods indoors together which can in turn change a potential resource for bolstering mental health in normal times (e.g. a supportive spouse) into a potential source of conflict. Due to longer hours spent indoors using electronic devices for recreation, individuals’ ability to foster quality sleep may likewise deteriorate which has been linked to poorer mental health generally, poorer immune system function, and a variety of chronic diseases [33].
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Although mental health has been considered a delicate topic for automated agents to operate in, there exists a growing literature body on utilizing CAs and TBCBs [10], [14], [34] to deliver high quality care. From this emergent stream of research, we have created the mental health module offering the topics of sleep, anxiety, loneliness and discovering mental resources, each composite of a series of sub-topics. Here coaching aims to allow individuals develop their own personal mental resources and offers boost mental resilience in the face of the current COVID-19 pandemic, as well as beyond it too. Following each coaching session, individuals are encouraged to select “tips” (i.e. behavioral intentions) related to their mental health, for example, engaging in “pleasant activity scheduling” from cognitive behavioral therapy [35].

Diet and nutrition

Diet and nutrition is well known to contribute to immune system resilience, general wellness, mental health, sleep and chronic disease development also [36]. In the current period of COVID-19, making sure individuals eat well and maintain a good diet is therefore a key part in boosting overall population health [37]. Eating habits often become routine [38], and for many individuals their current eating routines will be in a period of flux; additional time at home may provide the chance to re-assess previous eating habits, and with sufficient guidance, allow individuals to try and develop new routines as well as exerting greater control over the food they are preparing and eating. Alternatively, however, the breaking of routines may lead to other unhealthy habits (such as overeating) due to boredom or increased freedom (i.e. not limited to a “lunch hour” at work). In such circumstances, additional time, if used constructively, can allow individuals opportunity to try out new diet plans, food types and recipes. As part of a complete lifestyle coaching plan, diet and nutrition is planned for inclusion with an update of Elena+ following launch.
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CAs and TBCBs have been used in a variety of digital health interventions and coaching contexts targeting diet change with success. These include utilizing food diaries [39], recipe suggestions [40], logging weight and diet [41] for example. The module will function to provide nutrition and diet information and support individuals in making healthy choices, and influence outcomes expectancies and self-efficacy regarding food and diet choices. As with the other modules, individuals can choose to implement “tips” i.e. behavioral intentions, at the end of each coaching session.

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To see the Elena+ app in action, please view our screen cast here, or contact mail@elena.plus to receive test account credentials.

Elena+ features

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Personalized digital coaching

digital coaching in a variety of topics, delivered at your fingertips from the safety of your very home!

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COVID-19 guidance

keeping up to date with guidelines and what practical steps we can take to.

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Mental health support

anxiety, loneliness, sleep come all too easily in this difficult period of self-isolation. Elena offers you mental health support, created by an expert team of therapists and mental health researchers.

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Physical activity assistance

whether you are an avid gym goer or just looking to get more active, staying at home has its challenges for keeping active. Elena+ has a variety of tailored exercise and activity advice delivered by experts in movement science.

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Staying healthy

By using Elena+ you can maximise your health and reduce the strain on our healthcare system and healthcare workers.

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Fight pandemics, now and in the future

using Elena+ helps researchers understand how best to deliver care during pandemics, by Elena+ you help healthcare systems prepare themselves for future emergency situations and outbreaks.

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More to give

Elena+ is working hard for you to deliver new content direct from the experts and cutting edge science.

Meet the team

Elena+ was born of a team of volunteers, inspired by the sacrifice of our frontline healthcare workers, to create something that could alleviate COVID-19 related suffering. Click here to meet our interdisciplinary and international team of researchers, students and volunteers.

Show me the team!

We need your support!

As we are only a small team of volunteers inspired by the story of Elena, we need your help and resources to translate the content of Elena+ and reach across all EU member states and the wider world during this difficult time. To do this we need team members to help translate and implement new language support for our chatbot and market Elena in each and every member state to reach individuals suffering during this crisis. What’s more, with further resources comes the potential to further develop Elena: to act upon user feedback and integrate new features, as well as helping new vulnerable groups such as those with chronic diseases or those requiring specialist support.

We are all in this together

Join us now!

What’s Next

Elena+ is striving to make a difference with digital lifestyle coaching during the COVID-19 pandemic and beyond.
Up next, we will be:

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Implementing new coaching features, new coaching topics, and tailoring the intervention for at risk groups.

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Translating Elena+ to new languages and for new cultural contexts, to help make meaningful connections across the globe.

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Collaborating with researchers, practitioners and policy makers to help better understand “pandemic lifestyle care”, and plan for future health emergencies.

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Acting on coachee feedback, and iteratively improving our coaching services.

Partners

Center for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland

mtec.ethz.ch & www.c4dhi.org

Saw Swee Hock School Of Public Health, National University of Singapore, Singapore

sph.nus.edu.sg

School of Medicine, Johns Hopkins University, Baltimore, USA

www.hopkinsmedicine.org

Center for Digital Health Interventions, Institute of Technology Management, University of St.Gallen, St.Gallen, Switzerland

item.unisg.ch & www.c4dhi.org

University of the West of Scotland, Paisley, Ayr, Hamilton and Dumfries, Scotland

www.uws.ac.uk

Loughborough University, Loughborough, United Kingdom

www.lboro.ac.uk

Universidad de San Buenaventura, Colombia

www.usbbog.edu.co

Durham University, Durham, UK

www.dur.ac.uk

Department of Applied Psychology, University of Applied Sciences Zurich, Zurich, Switzerland

www.zhaw.ch

Trinity College Dublin, Dublin, Ireland

www.tcd.ie

Sooli Film, Stans, Switzerland

www.sooli.ch

flipping ROCKS, Furtwangen, Germany

www.flippingrocks.de

Official Participant of EUvsVirus

euvsvirus.org

Contact

Elena+
Joseph Brian Ollier
Doctoral Researcher
WEV G 225
Weinbergstrasse. 56/58
8092 Zürich
Switzerland
E-Mail: mail@elena.plus

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References
  1. World Health Organization, “Coronavirus disease 2019 (COVID-19): situation report, 67,” 2020.
  2. M. S. Q. Chua, J. C. S. Lee, S. Sulaiman, and H. K. Tan, “From the frontlines of COVID‐19 – How prepared are we as obstetricians: a commentary,” BJOG An Int. J. Obstet. Gynaecol., pp. 1471-0528.16192, Mar. 2020, doi: 10.1111/1471-0528.16192.
  3. P. Y. Weng and Y. C. Chiang, “Psychological restoration through indoor and outdoor leisure activities,” J. Leis. Res., vol. 46, no. 2, pp. 203–217, 2014, doi: 10.1080/00222216.2014.11950320.
  4. J. F. Wilson, “The crucial link between literacy and health.,” Ann. Intern. Med., vol. 139, no. 10, pp. 875–878, Nov. 2003, doi: 10.7326/0003-4819-139-10-200311180-
    00038.
  5. J. E. L. Wong, Y. S. Leo, and C. C. Tan, “COVID-19 in Singapore—Current Experience,” JAMA, vol. 323, no. 13, p. 1243, Apr. 2020, doi: 10.1001/jama.2020.2467.
  6. M. Fiordelli, N. Diviani, and P. J. Schulz, “Mapping mhealth research: A decade of evolution,” J. Med. Internet Res., vol. 15, no. 5, 2013, doi: 10.2196/jmir.2430.
  7. L. Laranjo et al., “Conversational agents in healthcare: A systematic review,” J. Am. Med. Informatics Assoc., vol. 25, no. 9, pp. 1248–1258, 2018, doi: 10.1093/jamia/ocy072.
  8. T. Kowatsch et al., “Text-based Healthcare Chatbots Supporting Patient and Health Professional Teams: Preliminary Results of a Randomized Controlled Trial on Childhood Obesity,” in Persuasive Embodied Agents for Behavior Change (PEACH2017), Stockholm, Sweden, August 27, 2017, 2017, doi: 10.3929/ethz-b-000218776.
  9. A. Fadhil and A. Villafiorita, “An Adaptive Learning with Gamification & Conversational UIs,” Adjun. Publ. 25th Conf. User Model. Adapt. Pers. – UMAP ’17, pp. 408–412, 2017, doi: 10.1145/3099023.3099112.
  10. S. Provoost, H. M. Lau, J. Ruwaard, and H. Riper, “Embodied Conversational Agents in Clinical Psychology: A Scoping Review,” J Med Internet Res, vol. 19, no. 5, p.e151, 2017, doi: 10.2196/jmir.6553.
  11. S. Hauser-Ulrich, H. Künzli, D. Meier-Peterhans, and T. Kowatsch, “A Smartphonebased
    Healthcare Chatbot to Promote Self-Management of Chronic Pain (SELMA): A Pilot Randomized Control Trial (Preprint),” JMIR mHealth uHealth, vol. 8, 2019, doi: 10.2196/15806.
  12. K. K. Fitzpatrick, A. Darcy, and M. Vierhile, “Delivering Cognitive Behavior Therapy to Young Adults With Symptoms of Depression and Anxiety Using a Fully Automated Conversational Agent (Woebot): A Randomized Controlled Trial,” JMIR Ment. Heal., vol. 4, no. 2, p. e19, 2017, doi: 10.2196/mental.7785.
  13. K. Kretzschmar, H. Tyroll, G. Pavarini, A. Manzini, I. Singh, and G. NeurOx Young People’s Advisory, “Can Your Phone Be Your Therapist? Young People’s Ethical Perspectives on the Use of Fully Automated Conversational Agents (Chatbots) in Mental Health Support,” Biomed Inf. Insights, vol. 11, p. 117822261982908, 2019, doi: 10.1177/1178222619829083.
  14. M. Stieger, M. Nißen, D. Rüegger, T. Kowatsch, C. Flückiger, and M. Allemand, “PEACH, a smartphone- and conversational agent-based coaching intervention for intentional personality change: Study protocol of a randomized, wait-list controlled trial,” BMC Psychol., vol. 6, no. 1, pp. 1–15, 2018, doi: 10.1186/s40359-018-0257-9.
  15. M. R. Lennon et al., “Readiness for delivering digital health at scale: Lessons from a longitudinal qualitative evaluation of a national digital health innovation program in the United Kingdom,” J. Med. Internet Res., vol. 19, no. 2, pp. 1–18, 2017, doi: 10.2196/jmir.6900.
  16. M. Hostetter, S. Klein, and D. McCarthy, “Taking Digital Health to the Next Level,” 2014.
  17. S. A. Taylor, C. Ishida, and L. A. N. Donovan, “Considering the Role of Affect and Anticipated Emotions in the Formation of Consumer Loyalty Intentions,” Psychol. Mark., vol. 33, no. 10, pp. 814–829, 2016, doi: 10.1002/mar.20919.
  18. T. Verhagen, J. van Nes, F. Feldberg, and W. van Dolen, “Virtual customer service agents: Using social presence and personalization to shape online service encounters,” J. Comput. Commun., vol. 19, no. 3, pp. 529–545, 2014, doi: 10.1111/jcc4.12066.
  19. S. Danckwerts, L. Meißner, and C. Krampe, “Examining User Experience of Conversational Agents in Hedonic Digital Services – Antecedents and the Role of Psychological Ownership,” J. Serv. Manag. Res., vol. 3, no. 3, pp. 111–125, 2019, doi: 10.15358/2511-8676-2019-3-111.
  20. G. Riva, “The sociocognitive psychology of computer-mediated communication: The present and future of technology-based interactions,” Cyberpsychology and Behavior, vol. 5, no. 6. pp. 581–598, 2002, doi: 10.1089/109493102321018222.
  21. D. Allington and N. Dhavan, “The relationship between conspiracy beliefs and compliance with public health guidance with regard to COVID-19,” 2020.
  22. R. B. Kelly, S. J. Zyzanski, and S. A. Alemagno, “Prediction of motivation and behavior change following health promotion: Role of health beliefs, social support, and self-efficacy,” Soc. Sci. Med., vol. 32, no. 3, pp. 311–320, Jan. 1991, doi: 10.1016/0277-9536(91)90109-P.
  23. Z. F. Chen and Y. Cheng, “Consumer response to fake news about brands on social media: the effects of self-efficacy, media trust, and persuasion knowledge on brand trust,” J. Prod. Brand Manag., vol. 29, no. 2, pp. 188–198, Oct. 2019, doi: 10.1108/JPBM-12-2018-2145.
  24. S. C. Herring, “Slouching Toward the Ordinary: Current Trends in Computer-Mediated Communication,” New Media Soc., vol. 6, no. 1, pp. 26–36, Feb. 2004, doi: 10.1177/1461444804039906.
  25. World Health Organization, “Considerations for quarantine of individuals in the context of containment for coronavirus disease (COVID-19): Interim guidance-2,” 2020.
  26. F. A. Treiber, T. Baranowski, D. S. Braden, W. B. Strong, M. Levy, and W. Knox, “Social support for exercise: Relationship to physical activity in young adults,” Prev. Med. (Baltim)., vol. 20, no. 6, pp. 737–750, Nov. 1991, doi: 10.1016/00917435(91)90068-F.
  27. B. Resnick, D. Orwig, J. Magaziner, and C. Wynne, “The effect of social support on exercise behavior in older adults.,” Clin. Nurs. Res., vol. 11, no. 1, pp. 52–70, Feb. 2002, doi: 10.1177/105477380201100105.
  28. D. Thompson and T. Baranowski, “Chatbots as extenders of pediatric obesity intervention: an invited commentary on ‘Feasibility of Pediatric Obesity & Pre-Diabetes Treatment Support through Tess, the AI Behavioral Coaching Chatbot,’” Transl Behav Med, vol. 9, no. 3, pp. 448–450, 2019, doi: 10.1093/tbm/ibz065.
  29. T. N. Stephens, A. Joerin, M. Rauws, and L. N. Werk, “Feasibility of pediatric obesity and prediabetes treatment support through Tess, the AI behavioral coaching chatbot,” Transl Behav Med, vol. 9, no. 3, pp. 440–447, 2019, doi: 10.1093/tbm/ibz043.
  30. S. Mohan, A. Venkatakrishnan, and A. L. Hartzler, “Designing an AI Health Coach and Studying its Utility in Promoting Regular Aerobic Exercise,” ACM Trans. Interact. Intell. Syst., vol. 1, no. October, p. 30, 2019, doi: 10.1145/nnnnnnn.nnnnnnn.
  31. Y. Huang and N. Zhao, “Generalized anxiety disorder, depressive symptoms and sleep quality during COVID-19 epidemic in China: a web-based cross-sectional survey,” medRxiv, p. 2020.02.19.20025395, Mar. 2020, doi: 10.1101/2020.02.19.20025395.
  32. M. G. Jiménez Ambriz, M. Izal, and I. Montorio, “Psychological and Social Factors that Promote Positive Adaptation to Stress and Adversity in the Adult Life Cycle,” J. Happiness Stud., vol. 13, no. 5, pp. 833–848, Sep. 2012, doi: 10.1007/s10902-011-9294-2.
  33. F. Cappuccio, M. A. Miller, and S. W. Lockley, Sleep, health, and society: From aetiology to public health. Oxford University Press, USA, 2010.
  34. S. Park et al., “Designing a Chatbot for a Brief Motivational Interview on Stress Management: Qualitative Case Study,” J. Med. Internet Res., vol. 21, no. 4, p. e12231, 2019, doi: 10.2196/12231.
  35. C. A. Padesky and D. Greenberger, Mind over mood: Change how you feel by changing the way you think. Guilford Publications Incorporated (US), 2015.
  36. S. A. Lanham-New, T. R. Hill, A. M. Gallagher, and H. H. Vorster, Introduction to human nutrition. John Wiley & Sons, 2019.
  37. M. Lawrence and T. Worsley, Public Health Nutrition. McGraw-Hill Education (UK), 2007.
  38. M. M. Jastran, C. A. Bisogni, J. Sobal, C. Blake, and C. M. Devine, “Eating routines. Embedded, value based, modifiable, and reflective,” Appetite, vol. 52, no. 1, pp. 127–136, Feb. 2009, doi: 10.1016/j.appet.2008.09.003.
  39. J. Casas, E. Mugellini, O. Abou Khaled, and O. A. Khaled, “Food Diary Coaching Chatbot,” UbiComp/ISWC 2018 – Adjun. Proc. 2018 ACM Int. Jt. Conf. Pervasive Ubiquitous Comput. Proc. 2018 ACM Int. Symp. Wearable Comput., no. November, pp. 1676–1680, 2018, doi: 10.1145/3267305.3274191.
  40. S. Gabrielli, K. Marie, and C. Della Corte, “SLOWBot (chatbot) lifestyle assistant,” in ACM International Conference Proceeding Series, 2018, pp. 367–370, doi: 10.1145/3240925.3240953.
  41. S. Holmes, A. Moorhead, R. Bond, H. Zheng, V. Coates, and M. McTear, “WeightMentor, bespoke chatbot for weight loss maintenance: Needs assessment & Development,” 2020, pp. 2845–2851, doi: 10.1109/bibm47256.2019.8983073.